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UW helps spur Wyoming’s quest toward a health care model centered on each patient

Volume 14 | Number 1 | September 2012

By Steve Kiggins
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From the outside, the Casper Family Medicine Residency Center (FMRC) looks like an ordinary building. It’s when you go through the automatic sliding front doors and leave the spacious reception area that you find out it’s not.

“It’s sort of like an octopus,” Lona Cantine says with a smile and a laugh as she leads the way past one of the FMRC’s many nursing stations.

You could easily get lost here, in a seemingly endless maze of hallways, in a place where one patient room usually looks like the next.

Which way is which?

“See why we call it an octopus?” asks Cantine.

But don’t be scared. No matter which way you turn, no matter where you end up in this immense building, you’ll find help.

The University of Wyoming-operated Casper FMRC, a fixture since 1979 in one of the Cowboy State’s largest communities, is a prime example of a patient-centered medical home. Whether you need a physical, an X-ray, a blood test or an ultrasound, you are in the right place.

“Patient-centered health care is so important because the current model of providing health care does not work for many, if not most, people,” says Joseph F. Steiner, dean of the UW College of Health Sciences. “It is uncoordinated and does not appreciate individual differences. It also puts the values of the health care provider before those of the patient—and then we wonder why the patient does not follow instructions.

“The patient-centered medical home reverses the model by allowing the patient to become the director of his or her own plan for staying healthy and treating illness.”

The team-based delivery of a patient-centered medical home is especially beneficial for Wyoming, a heavily rural state with one of the fastest aging populations in America. The patient-centered model allows for less travel and broadens the provision of care in a state that is short of professionals in virtually every field of health care.

There may be another advantage, too. “This model,” says Steiner, “may actually save health care dollars.”

‘We lost touch with the patient’

Wyoming’s ability to deliver quality health care focused on the best interests of each patient—“It’s not about how many we see, it’s about how well we see who we see,” says Dr. Cindy Works, who specializes in geriatrics at the Casper FMRC—will depend largely on UW’s efforts to train the next generation of physicians, nurses, pharmacists, physical therapists and other health care professionals.

In addition to the Casper center—the building with all those tentacles at 1522 E. A St. also includes a private retail pharmacy in the lobby and social workers and a psychiatrist on the basement level—UW is in the process of modeling a patient-centered medical home at its Cheyenne Family Medicine Residency Center, located about two blocks west of Holliday Park at 821 E. 18th St.

Also, UW has partnered with Cheyenne Regional Medical Center, the Wyoming Integrated Care Network and other state agencies on a three-year, $14.4 million grant from the Center for Medicare Services that will study provision of patient-centered health care throughout Wyoming.

“The family practice doctor needs to know the patient like nobody else does, and that takes time,” says Works, a Casper native and graduate of the WICHE exchange program offered through UW. “When I train residents, they learn the team approach and that your medicine is only as good as your team. That’s a big part of the educational component here.

“We want to talk to our patients and focus on them and not just run a bunch of tests. What I try to teach the residents is their procedure,” she says. “They’re not the surgeon. They’re not the gastroenterologist. They’re not the nephrologist. Their procedure is knowing all the details about their patient: the social history, the goals of care, the family history, a really accurate medication list. You’re the detail manager. You’re the one who says to the specialist, ‘But what about this?’ and ‘Did you realize they also have this medical problem?’”

Patient-centered health care isn’t a newfangled idea. In fact, Dr. Douglas Parks, an associate professor of family medicine at the Cheyenne FMRC, remembers the days when it was the norm.

“But as clinics got bigger and bigger and the health care system got bigger and bigger, we lost touch with the patient. That’s a much less efficient way of doing things,” says Parks, who has a special interest in the skills needed by physicians practicing in rural areas as well as innovative ways to recruit and retain physicians for rural practices. “So, really, the patient-centered medical home is about getting back to the way it was when I was a kid.”

He adds, “We’re fortunate in Wyoming to have a teaching place for students like the residency centers here in Cheyenne and in Casper. Service and education are tied together, hand in hand. There is no way to separate one from the other.”

 ‘What can we do for this patient?’

It took many years, says Parks, for health care to veer off course. It’s going to take many years to get back on track, too.

“The bottom line,” he says, “is to get it set up again so that the patient comes first.”

That is happening at the Casper FMRC’s Geriatric Assessment Clinic. Through a grant secured by the UW Geriatric Education Center, Works comes together with a behaviorist, case manager, physical therapist, occupational therapist, pharmacist and students to evaluate four cases each month.

“It’s an all-in: What can we do for this patient?” says Works, who began at the Casper FMRC in 1991, including the past 10 years on a full-time basis. “That team, in a nutshell, is what patient-centered health care is all about.”

It’s a step, albeit a small one, toward a health care model designed to meet the individual needs of each patient. And though the numbers are daunting—the Casper FMRC, with a staff of about 40 health care providers, including faculty and residents, is on pace this year to exceed 30,000 visits from some 9,000 patients—Cantine says the clinic will continue to emphasize personalized attention.

“I always say that it takes special people to take care of special people,” the clinic director says. “That’s how we feel about our patients. That’s how we feel about our staff.”

Wyoming could use a few more health care facilities like that one. The maze of hallways and all.

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